Develop. Med. Child Nerirol. 1975, 17,602-604

Preventing Dental Caries in Children: Report of a Swedish Programme Kerstin Holst Lennart Kohler

Introduction Dental health care should be the concern of everyone interested in the total health of children, for although dental caries seldom endangers life, it may be painful, debilitating and expensive, and may in some cases contribute to long-term suboptimal health. The key to dental health is prevention, and if prevention is to be effective a large proportion of the population must be reached early. In this respect, general health programmes for children offer the best opportunities.

surfaces) were found to be 10.6 per cent in the city children and 21.7 per cent in the rural children. Significantly better oral health was found in higher socioeconomic groups. When information on the children’s eating habits, oral hygiene and previous dental care was related to the finding of caries, it was demonstrated that the most important factors for achieving better oral health were-in order-infrequent eating between meals, brushing the teeth with help from parents, and the oral adminis[ration of fluoride from an early age. Based on these findings, a programme for dental health within the child-health services was worked out. I t began in 196768 and is co-ordinated with the routine medical examinations at child-health centers-which have a very high attendance rate-and works in the following way. The dentist meets the parents when a child is five to six months old and talks to them about what causes caries and gingivitis. He stresses the importance of oral hygiene and, in consultation with a paediatrician, gives advice on food and eating habits. If the fluoride content of the drinking water is low in the area where the child lives, oral fluoride is prescribed and

Dental Health Programme An epidemiological study of child health in Sweden included an evaluation of the dental health of 1,327 four-year-olds (Kohler and Holst 1973). The frequency of caries in these children was found to be extremely high-73 6 per cent in those from the city and 88.6 per cent in those from a rural district. The mean defi (decayed, extracted and filled)* was 7.7 per cent and 13.1 per cent, respectively. Emergency cases (need of pulpotomy or extraction of two or more molars in combination with 15 or more decayed

* Also known in the United Kingdom as the dmfrate (decayed, missing or filled).

Correspondence to Dr. Lennart Kohler, Department of Pediatrics, University Hospital, S-221 85 Lund, Sweden.

602

KERSTIN HOLST

LENNART KOHLER

its importance in caries prevention is emphasised to the parents. Second and third meetings are arranged when the child is aged nine to 12 months and 18 to 24 months. If possible, a clinical examination is done at these times. The information given during the first interview is repeated and supplemented, according to parents’ questions and the clinical findings. Tooth-brushing techniques are demonstrated on a model or on the child himself. Discussions are held about preventive orthodontics. This programme is now functioning all over the county of Lund in Sweden. Usually the interviews are conducted by dentists but, when available, dental hygienists seem to accomplish the same programme very well. Since 1974, every child in Sweden is included by law in organized dental care from the age of three years, which means regular and complete treatment by a dentist once a year. This is free of charge up to the age of 16 years. From 1980 it will extend to the age of 19 years.

decrease -in the number of children with wide sprkad caries was also noted: in 1969, 19.5 per cent had more than six carious teeth, in 1973 the figure was 6.8 per cent. The prevention of caries, both by instruction to the parents and by clinical supervision, is not limited to child-health centers. Local fluoride administration is undertaken regularly once a week in nurseries, kindergartens and schools. As a result, school-children have better teeth. In a group of children born in 1958 and examined a t seven years of age, 5.3 per cent were free of caries; the figure for children born in 1966 and examined at seven years was 20 per cent. The mean number of carious permanent teeth was reduced from 2.5 to 1 - 6 per cent. By these preventive measures in early life, the need for dental treatment for pre-school and school-children has been considerably reduced. This means not only better general health among the child population but also less expenditure for the family and community. Similar dentalhealth programmes in other parts of Sweden have also reported a reduction of caries (Forsman 1974). The National Board of Health and Welfare (1971) stated that advice on dental health should be routine from infancy in the childhealth services all over Sweden.

Resu1ts With the instigation of our local preventive programme there has been a substantial reduction of caries in preschool children (Table). In a group of four-year-olds who had been on the programme for two years, the percentage of those who were free from caries increased from 26.4 per cent to 42 per cent. In 1973, when the programme had been running for six years, it was 60 per cenr. A marked

AUTHORS’APPOINTMENTS Kerstin Holst, Head, County Preventive Dental Service, Lund, Sweden. Lennart Kohler, M.D., Assistant Professor, Department of Pediatrics, University Hospital, Lund, Sweden.

TABLE Age of children at examination 4 years, born 1963 (n = 1313) 4 years, born 1965 (n = 697) 4 years, born 1969 (n = 688) 7 years, born 1958 (n = 490) 7 years, born 1966 (n = 701)

~

i ,

i,

Perceniage of children without caries

I ~

Mean number of carious teeth

26.4 42.0 60.6

4.6 3.2 1.6

5.3 20.0

2.5 1.6

603

DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY.

1975, 17

SUMMARY

A comprehensive programme of dental health care for Swedish children aged from six months to 16 years is briefly described. RESUME

Privention dds caries dentaires chez les enfants Un programme de soins de santC dentaire pour les enfants suCdois de six mois A seize ans est britvement dtcrit. ZUSAMMENFASSUNG

Verhinderung yon Zahnkaries bei Kindern Es wird kurz ein Programm wiedergegeben, das die Gesunderhaltung der Zahne bei schwedischen Kindern im Alter von 6 Monaten bis zu 16 Jahren beschreibt. RESUMEN

Prevencidn de la caries dental en 10s niiios Se describe brevemente un programa de salud dental para niiios suizos de edades desde 6 nieses hasta 16 aiios.

REFERENCES Forsman, B. (1974) Fluoride and Dental Health: Investigations in Swedish Children. Stockholm: Karolinska Institutet. Kohler, L., Holst, K. (1973) ‘Dental health of four-year-old children.’ Acta Paediutricu Scundinavicu 62,269. National Board of Health and Welfare (1971) ‘Odontologisk ridgivning vid barnavhrdscentral’ R i d och anvisningar frin Socialstyrelsen, no. 25.

604

Preventing dental caries in children: report of a swedish programme.

Develop. Med. Child Nerirol. 1975, 17,602-604 Preventing Dental Caries in Children: Report of a Swedish Programme Kerstin Holst Lennart Kohler Intro...
165KB Sizes 0 Downloads 0 Views